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Impact of robotic access on outcomes after lung cancer surgery in France: Analysis from the Epithor database

Open AccessPublished:March 17, 2023DOI:https://doi.org/10.1016/j.xjon.2023.02.018
Impact of robotic access on outcomes after lung cancer surgery in France: Analysis from the Epithor database
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      Abstract

      Introduction

      We aimed to compare postoperative outcomes after pulmonary resection for lung cancer after open thoracotomy (OT), video-assisted (VATS) and robotic-assist (RA) thoracic surgery using a propensity score analysis.

      Methods

      From 2010 to 2020, 38,423 patients underwent resection for lung cancer. 58.05% (n=22,306) were operated by thoracotomy, 35.35% (n=13,581) by VATS and 6.6% (n=2,536) by RA. A propensity score was used to create balanced groups with weighting. End points were: in-hospital mortality, postoperative complications and length of hospital stay, reported by odds ratios (OR) and 95% confidence intervals (CI).

      Results

      VATS decreased in-hospital mortality compared to OT (OR=0.64(0.58-0.79);p<0.0001) but not compared to RA (OR=1.09(0.77-1.52);p=0.61). VATS reduced major postoperative complications compared to OT (OR=0.83(0.76-0.92);p<0.0001) but not RA (OR=1.01(0.84-1.21);p=0.17). VATS reduced prolonged air leaks rate compared to OT (OR=0.9(0.84-0.98);p=0.015) but not RA (OR=1.02(0.88-1.18);p=0.77). As compared to OT, VATS and RA decreased: the number of atelectasis, respectively (OR=0.57(0.50-0.65);p<0.0001) and (OR=0.75(0.60-0.95);p=0.016); the number pneumonia (OR=0.75 (0.67-0.83);p<0.0001) and (OR=0.62(0.50-0.78);p<0.0001); the number of postoperative arrhythmias (OR=0.69(0.61-0.78);p<0.0001) and (OR=0.75(0.59-0.96);p=0.024). Both VATS and RA were resulted in shorter hospital stays (-1.91days (-2.24;-1.58); p<0.0001 and -2.73days (-3.1;-2.36);p<0.0001, respectively).

      Conclusion

      RA seemed to decrease postoperative pulmonary complications as VATS compared to OT. VATS decreased postoperative mortality as compared to RA and OT.

      Graphical abstract

      Figure thumbnail fx1
      Graphical Abstract

      Key words

      Glossary of abbreviations:

      ASA (American Society of Anesthesiologists), BMI (Body Mass Index), CI (Confidence Interval), DFS (Disease Free Survival), FEV1 (Forced Expiratory Volume in One Second), HR (Hazard Ratio), IPTW (Inverse Probability for Treatment Weighting), IHM (In-hospital mortality), LOS (Length of Hospital Stay), LC (Lung Cancer), NNIS (National Nosocomial Infection Surveillance Risk index), OR (Odds Ratio), OS (Overall survival), OT (Open Thoracotomy), PAL (Prolonged Air Leaks), PS (Propensity Score), RA (Robotic-Assist), RCT (Randomized Controlled Trial), VATS (Video-Assisted Thoracic Surgery), WHO (World Health Organization)

      Article info

      Publication history

      Accepted: February 21, 2023
      Received: January 14, 2022

      Publication stage

      In Press Journal Pre-Proof

      Footnotes

      Conflicts of interest and source of funding

      PBP, JMB receive consulting fees from Medtronic. PBP, JMB, MD receive consulting fees from Intuitive surgical.

      The other authors have no disclosure to declare for this work.

      Central picture legend: Effect of thoracic robotic surgery on pneumonia and hospital stay during 2010-2020.

      Central message

      In lung cancer surgery, RA is a safe and feasible technique that reduces significantly postoperative complications when compared to OT.

      Perspective statement

      The benefice of short and long-term outcomes in lung surgery, with minimally invasive approaches and open thoracic surgery are still controversial. In our retrospective study with propensity score analysis, RA seemed to be associated with a significant reduction of atelectasis pneumonia, sepsis, hemorrhage, arrhythmia and LOS compared to OT in our French surgical population, suggesting that it is a safe and feasible surgical technique for early stage LC.

      Identification

      DOI: https://doi.org/10.1016/j.xjon.2023.02.018

      Copyright

      © 2023 The Authors. Published by Elsevier Inc. on behalf of The American Association for Thoracic Surgery

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